Cloverdale Convalescent & Rehab

Total Number of Beds: 46	Percent of Occupied Beds: 89%
Total Number of Residents: 41	Located Within a Hospital: No
Type of Ownership: For profit - Corporation	Multiple Nursing Homes by Same Owner: No
Councils the Nursing Home Participates in: Resident	Medicare/Medicaid: Participating in Medicare and Medicaid
* Details Last Reported on: 02/26/2003

Nursing Home Staff Information:

Number of RN Hours per Nursing Home Resident per Day: 0.4

Number of LPN/LVN Hours per Nursing Home Resident per Day: 0.87

Number of CNA Hours per Nursing Home Resident per Day: 2.07

Number of Staff Hours per Nursing Home Resident per Day: 3.34

Nursing Home Resident Information**:

Percent of Residents Who Have Moderate to Severe Pain: 29%
Percent of Residents Who Spend Most of Their Time in Bed or in a Chair: 0%
Percent of Residents Who are More Depressed or Anxious: 27%
Percent of Residents Who Were Physically Restrained: 0%
Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder: 0%
Percent of Residents With a Urinary Tract Infection: 9%
** Details Last Reported on: 2/26/2003

Nursing Home Inspection Violations:

Date of Violation	Date Corrected	Type of Violation	Deficiency	Scope	Level of Harm
2001-01-23	2001-01-24	Quality Care Deficiencies	Make sure that residents with loss of bladder control receive treatment or service to prevent infections and help get normal bladder control.	Isolated	Actual harm
2001-01-23	2001-01-24	Quality Care Deficiencies	Give proper treatment to residents with feeding tubes to prevent problems (such as aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, nasal-pharyngeal ulcers) and help restore eating skills, if possible.	Isolated	Minimal harm or potential for actual harm
2001-01-23	2001-01-24	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Pattern	Minimal harm or potential for actual harm
2001-01-23	2001-01-24	Nutrition and Dietary Deficiencies	Store, cook, and give out food in a safe and clean way.	Pattern	Potential for minimal harm
2001-01-23	2001-02-05	Environmental Deficiencies	Get rid of garbage properly.	Pattern	Potential for minimal harm
2001-01-23	2001-01-24	Environmental Deficiencies	Provide enough emergency electricity.	Pattern	Immediate jeopardy to resident health or safety
2001-01-23	0000-00-00	Environmental Deficiencies	Provide rooms that are big enough for each resident.	Pattern	Minimal harm or potential for actual harm
2001-01-23	2001-01-24	Environmental Deficiencies	Have enough backup water supply for important areas of the nursing home.	Widespread	Potential for minimal harm
2002-04-17	2002-05-10	Resident Rights Deficiencies	Tell each resident who can get Medicaid benefits about 1) which items and services Medicaid covers and which the resident must pay for; or 2) how to apply for Medicaid, along with the names and addresses of State groups that can help.	Pattern	Potential for minimal harm
2002-04-17	2002-05-10	Quality Care Deficiencies	Provide activities to meet the needs of each resident.	Isolated	Minimal harm or potential for actual harm
2002-04-17	2002-05-10	Quality Care Deficiencies	Make sure that residents who cannot care for themselves receive help with eating/drinking, grooming and hygiene.	Pattern	Minimal harm or potential for actual harm
2002-04-17	2002-05-10	Quality Care Deficiencies	Make sure that residents with loss of bladder control receive treatment or service to prevent infections and help get normal bladder control.	Isolated	Minimal harm or potential for actual harm
2002-04-17	2002-05-10	Environmental Deficiencies	Make sure that the nursing home area is free of dangers that cause accidents.	Pattern	Minimal harm or potential for actual harm
2002-04-17	2002-05-10	Quality Care Deficiencies	Make sure each resident is being watched and has assistance devices when needed, to prevent accidents.	Pattern	Minimal harm or potential for actual harm
2002-04-17	2002-05-10	Pharmacy Service Deficiencies	1) Make sure that residents who take drugs are not given too many doses or for too long; 2) make sure that the use of drugs is carefully watched; or 3) stop or change drugs that cause unwanted effects.	Isolated	Minimal harm or potential for actual harm
2002-04-17	2002-05-10	Environmental Deficiencies	Have a program to keep infection from spreading.	Pattern	Minimal harm or potential for actual harm
2002-04-17	2002-05-10	Environmental Deficiencies	Provide rooms that are big enough for each resident.	Pattern	Potential for minimal harm
2003-02-26	2003-03-07	Environmental Deficiencies	Make sure that staff members wash their hands when needed.	Pattern	Minimal harm or potential for actual harm
2003-02-26	2003-03-30	Environmental Deficiencies	Provide rooms that are big enough for each resident.	Isolated	Minimal harm or potential for actual harm

*** All violations listed are based on federal government records.